AB
929 -- Radiation Exposure: This measure would require the Department
of Health Services to establish quality assurance standards for
all radiological equipment in California to ensure that the lowest
possible dose of radiation is used without sacrificing imaging quality.
This measure took effect 1/1/06. Read more at California Assemblywoman
Jenny Oropeza'sweb page.

Limiting X-ray exposure

By Edie Lau -- Bee Science Writer

One
in a series of reports on new laws that take effect in the new year.

Her
bout with cancer last year caused Assemblywoman Jenny Oropeza to think
about the many things that damage cells in the body. Her exploration
led her to something that many people think of as strictly helpful,
not harmful, to their health: medical X-rays.

As
a California lawmaker, Oropeza is in a position to try to change that.
The Long Beach Democrat has taken what she hopes is a first step with
the passage this year of Assembly Bill 929, the California Radiation
Exposure Information Act.

The law, which takes
effect Jan. 1, requires the state Department of Health Services to develop
mandatory quality-assurance standards for all radiological equipment
in California to ensure the lowest possible dose of radiation without
sacrificing image quality.

The issue of medical
X-ray toxicity was a hot topic in science circles in 2005. Early in
the year, the National Toxicology Program - a part of the National Institute
on Environmental Health Sciences - announced it had added X-radiation
and gamma radiation to the nation's official list of known human carcinogens.

In June, the National
Research Council completed a five-year study of the biological effects
of exposure to low levels of ionizing radiation.

The study found
that even the smallest exposure is likely to cause a small increase
in health risk to humans.

Oropeza and her
staff in the Assembly looked into the subject. They discovered that
while the state has quality-assurance guidelines for users of medical
radiological equipment, abiding by the standards wasn't required.

The one exception
is mammography. A 1992 federal law set mandatory standards for mammography
involving credentialing of personnel and equipment maintenance.

So, while the tools
of mammography must be inspected annually, other radiological equipment
is examined by the state much less frequently.

According to Kevin
Reilly, deputy director of prevention services at the state health department,
equipment used in hospitals is considered by state law to be the highest
priority. It must be inspected once every three years.

Equipment considered
"medium priority" must be inspected every 4 1/4 years.
Dental equipment is in its own category. Sources of radiation used in
dentistry must be screened for defects by mail at least once every five
years on average. Half of the dental equipment must be physically inspected
at least once every six years on average.

While scientists
and lawmakers are paying more attention to the potential dark side of
medical radiology, no one questions that the tools can and do save lives.

Charles Meyers will
speak to that. Meyers had a computed tomography (CT) scan of his left
foot on Tuesday after he fell off a ladder and ended up at Mercy General
Hospital's emergency room with what he suspected was a broken heel.

It was the second
CT scan he's had recently, and he didn't worry for a moment about the
radiation exposure.

"Two years
ago, I had a CT scan on my lungs," said Meyers, a former Sacramento
resident who was back in town visiting a friend. "Without it, I
wouldn't have known I had clots in my lungs. It was definitely a life-saving
procedure."

Oropeza said her
concern is not the procedures that are medically necessary. Her target
is the stuff that's unnecessary.

An example, she
said, are full-body CT scans. "It's really popular with your younger
(to) middle-aged, upwardly mobile people. They view it as a preventive
thing where they go in, they pay 1,000 bucks or something ... and put
a full-body scan on them that's totally unnecessary," she said.

The same trend prompted
the National Toxicology Program to look into the health effects of radiation,
an act that led it to add X-rays and gamma rays to the list - now 58
items long - of known human carcinogens.

"People were
beginning to use more and more of these CT scans, which are equivalent
to 100 to 400 X-rays at one shot," said Christopher Portier, associate
director of the National Toxicology Program. "... That might not
be a risk-free exercise, and people need to be reminded of that."

Lorenza Clausen,
a radiology technologist at Mercy General, said the public should understand
that even medically necessary procedures can result in significant exposure
to radiation, too - exposure that she said can be reduced with training
of medical personnel.

The use of fluoroscopy
is an example. A form of real-time imaging that involves radiation,
fluoroscopy is used increasingly in the treatment of heart problems,
Clausen said. The imaging can enable a doctor to relieve blockage by
inserting a stent into the clogged artery, thereby avoiding open-heart
surgery.

Avoiding open-heart
surgery is a good thing, of course, but the fluoroscopy is not benign,
Clausen said. And a less-skilled physician might unwittingly expose
a patient - along with everyone else in the room - to more radiation
than is necessary.

"I've heard
of (exposures) of 20 and 40 minutes at a time," she said. "That's
a lot."

Reilly at the state
health department said it's not clear whether rules that result from
the new law will require that patient exposures are measured. The department
is drafting regulations, which will be aired for public comment before
going into effect by January 2008.

Oropeza said she
is mindful of the need for individuals to keep better track of their
medical radiation exposures. She considered legislation to require that
radiation records be kept for patients, similar to vaccination records,
but said the logistics were too complicated to work out during the legislative
session. Oropeza may resurrect the idea.

"We're going
to look at other ways of educating people to be more aware about especially
unnecessary exposure," she said.

NEW LAW AT A GLANCE

Assembly
Bill 929, the California Radiation Exposure Information Act, requires
the state Department of Health Services to develop mandatory quality-assurance
standards for all radiological equipment in California to ensure the
lowest possible dose of radiation.